Second Round of Treatment Does Not Improve PFS in Multiple Myeloma

Single autologous HCT followed by lenalidomide maintenance may be preferable for most MM patients.

The addition of consolidation chemotherapy or a second autologous hematopoietic cell transplantation (HCT) to upfront treatment was not superior to a single autologous HCT followed by lenalidomide maintenance in patients with multiple myeloma, a study presented at the American Society of Hematology (ASH) 58th Annual Meeting and Exposition has shown.1

Although lenalidomide maintenance after autologous HCT has improved progression-free and overall survival in patients with multiple myeloma, the benefit of additional therapies after autologous HCT, such as tandem autologous HCT or triple therapy consolidation, remains unclear.

The results showed no significant difference in the 38-month progression-free survival rate, the study's primary end point, between the 3 treatment arms. Researchers estimated progression-free survival at 38 months in 57% (95% CI, 50-63) of patients given ACM, 56% (95% CI, 49-63) of those who received TAM, and 52% (95% CI, 45-59) of those in AM.

Researchers also found that the 38-month estimated probabilities for overall survival were 86% (95% CI, 80-90), 82% (95% CI, 76-87), and 83% (95% CI, 78-88) with ACM, TAM, and AM, respectively. Median overall survival has not been reached.

"These results are very important because they answer a question that has been ongoing and has not been compared head-to-head: 'Does the addition of these interventions result in a true advantage for these patients?'" said lead investigator Edward A. Stadtmauer, MD, of the Abramson Cancer Center, University of Pennsylvania in Philadelphia.

"The conclusion of this study, so far, is that the other interventions are not superior to initial melphalan therapy followed by a single autologous HCT followed by lenalidomide maintenance," Dr Stadtmauer said.

A long-term follow-up trial to continue tracking outcomes of these patients is ongoing.

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